Medical staff in Nablus have been caring for premature babies born to Gazan mothers who have been unable to reunite with their children. (Veronique de Viguerie)

NABLUS, West Bank - The tiny twins didn’t cry like the other babies did. Their small sounds and snuffles were barely audible above the lilting bleeps of incubators in the neonatal ward. It wasn’t normal, the staff agreed, but no one had been able to reach their mother.

Her phone number was scrawled on a Post-it note tacked to the inside of 3-month-old Muayyed’s plastic cot - so the nurses could keep sending her pictures of the babies, could keep calling until someone picked up. The silences lasted days, sometimes longer.

“To be separated like that,” a nurse murmured as she smoothed a pink blanket around the sleeping child, “it’s a terrible thing.”

When Israel sealed its border with the Gaza Strip after Hamas’s deadly assault on Oct. 7, Muayyed and Mahmoud were among several dozen premature babies receiving care at neonatal wards in Israel and the occupied West Bank. Now, a war that has claimed the lives of more than 11,000 Gazans and erased entire families has also parted newborns from their mothers and fathers.

Before the conflict, Palestinians were only allowed to leave Gaza and enter Israel under special circumstances, including for lifesaving medical treatment that is not available in the enclave after 16 years of an Israeli and Egyptian blockade.

The Nablus hospital caring for Muayyed and Mahmoud receives about 40 women from Gaza with high-risk pregnancies each year - each of them granted a permit to enter Israel for a period of weeks. If a baby needs to stay in an incubator longer, some mothers return to Gaza to apply for permits all over again.

Israeli and Palestinian authorities do allow for mothers’ permits to be extended without a return to Gaza. But patient advocates and hospital staff who help women with the process say these on-the-ground extensions can be difficult to obtain and are not consistently granted. One of the mothers in this story said she was not aware that she could apply for an extension, and left without doing so.

With the Erez crossing closed, Israel has not issued exit permits to Gazans since the conflict began, leaving the mothers who returned unable to leave. In a statement on Dec. 24, a spokesperson for the Israeli agency that implements policies in Gaza and the West Bank blamed the “barbaric raid” by Hamas militants that killed 1,200 Israelis as the primary reason mothers and children remain separated. The spokesperson, whose office is known as Coordination of Government Activities in the Territories (COGAT), said Israel may eventually use an alternate border crossing to return infants to their mothers in Gaza if the children’s medical conditions permit.

The spokesperson spoke on the condition of anonymity under Israeli government practice.

Before the war began, the distress of new Gazan mothers deepened as the expiry date on their permits neared, hospital officials recalled. When the mothers were returning to Gaza, a hospital could simply offer them one last chance to scoop their babies from their incubators and hold them close. The mothers left in “agony,” one hospital administrator said.

Most of the medical staff and Palestinian mothers interviewed for this story spoke on the condition of anonymity, citing security concerns. In the aftermath of Oct. 7, hundreds of Palestinians from Gaza, including hospital patients with permits, were arbitrarily detained by security forces, rights groups say.

A nurse attends to a premature baby named Saaidah inside an incubator at a hospital in Israel on Wednesday. Saaidah's parents are in Gaza. (Salwan Georges/The Washington Post)

The mothers trapped in Gaza have spent weeks cowering in fear as Israeli airstrikes shake the earth and ground forces encircle the north of the enclave. Rooms that expectant parents decorated lovingly for new babies have been smashed. Clothes that infants would have worn in their earliest weeks have been lost to the rubble.

With communication networks shaky, text messages pleading for news of the babies’ health often don’t go through; the photographs sent back don’t always download. At times, the territory has been plunged into a near-total blackout, and the updates stopped flowing altogether.

Muayyed and Mahmoud were born on Aug. 3 at just 29 weeks, each weighing about 3 ½ pounds. By Aug. 5, the hospital told their mother, Sabrine, that it was time for her to go, staff members said. She left in tears, they said, reassured only by the hospital’s promise to help her apply for another permit as soon as possible so she could return to collect them.

Israeli authorities rejected it without explanation, hospital staff said. The war began soon after that.

When staff members try to phone Sabrine, the conversations are brief, if the signal holds at all. They always say that the twins are safe, that they are hers. That they will be here waiting when the skies fall silent and she will take them home.

The Nablus ward was brightly lit and quiet, aside from the beeping monitors. Staff in blue gowns spoke in hushed tones. A young nurse stood watch over the twins, now out of incubators and lying quietly in their cots.

Muayyed has long eyelashes. In her sleep, her lips flicker upward, like she’s smiling. “My nurses care about all of our babies, but their bond with the babies from Gaza is a special one,” said Moath, a pediatrician in charge of the ward. “We do our best to compensate for the love and care that she’s missing, but it’s not the same.”

Some staff members return to the ward after work to play with the twins. They are worried about them.

Without the constant attention of a parent or full-time caregiver, the babies are under-stimulated. They can’t learn to focus, or study the faces of adults gazing down at them to copy their sounds and expressions.

With no end to the war in sight, hospitals are improvising. At an Israeli facility visited by The Washington Post, social workers had found volunteers to give the separated babies skin-to-skin contact. “We made the request and within a day we had a whole list of people,” one of the social workers said. They chose several women who live close by; they now come to the hospital every day. “We chose people who really knew how to care for them,” the social worker said.

The Post is not providing the name or location of the hospital for the security of patients, as staff members fear reprisals from Israeli authorities.

Saaidah in her incubator at a hospital in Israel. When Saaidah experienced intestinal problems, doctors at the hospital had to decide whether to operate on her, without being able to reach her family in Gaza. (Salwan Georges/The Washington Post)

When one of the hospital’s premature babies, Saaidah, experienced serious intestinal problems, doctors got the mother’s consent to operate. They couldn’t reach her the second time it happened and had to decide whether to rely on the previous permission.

“It went against all of the ethics we are trained in, but we had to save her life,” a doctor said. It was 10 days until they heard from the mother again, and she greeted the news with relief.

Doctors fear what state Gazan mothers might return in, if they return at all. Of the more than 28,000 Gazans injured over the past six weeks, many are women. Even in peacetime, mothers reunited with their babies after a long separation have sometimes had difficulties bonding with them.

“We had a woman who wasn’t able to return for eight months,” the hospital administrator recalled. “She barely knew her child at first; she didn’t know how to hold her.”

Hanan al-Bayouk, reached by phone in the city of Khan Younis in southern Gaza before a communications blackout, only saw her triplets twice after they were born on Aug. 28. Thirty hours after giving birth, she said, the hospital told her that her permit had expired and that she would have to return to Gaza. She did not know the permit could be extended, she said.

They were IVF children - a miracle, it had seemed - but seeing them hooked up to oxygen tubes in glass incubators had been disorienting. “I didn’t know whether to feel happy or anxious,” she said. “I was nervous; I dreamed of hugging them.” The smallest was Nour, weighing less than 3 pounds.

Bayouk later secured a permit to return for their discharge. It was dated Oct. 10, four days too late.

She and her husband, Fathi, had bought clothes and toys. They had prepared a room. As fighting rages around their city, she stands among the empty cribs.

“I see them everywhere around me,” she said, her voice breaking. “I am afraid that I will be killed in this war, and I will not be able to see them again and I do not know who will take care of them.”

“We see entire families being removed from the civil registry. What if we are the next target?”

For now, Nour and her sisters lie in hospital cots, with SpongeBob SquarePants on one wall and a young boy sitting in a crescent moon on another. Bayouk’s whole family has seen the photos of the girls sleeping peacefully there. “Will we really see them?” they keep asking. In calmer moments, they sit together and talk about the party they will throw for the triplets when they come home.

Not one night has passed, Bayouk said, when she hasn’t dreamed of holding her children. They will be 3 months old in a couple of weeks.

Harb reported from London.